IV Ketamine Therapy for depression that hasn’t responded
When antidepressants, therapy, and the usual combinations haven’t moved the needle, there’s a different mechanism worth considering. IV ketamine is a slow, physician-supervised infusion used off-label for treatment-resistant depression, PTSD, and chronic pain with a psychological component.
What IV Ketamine Is
A different pathway, when the usual ones haven’t worked
Finding out your medication isn’t working again is its own kind of exhausting. IV ketamine therapy is a slow intravenous infusion of racemic ketamine, used off-label for depression and other conditions that haven’t responded to the standard playbook of oral antidepressants and therapy.
Ketamine works on the brain’s glutamate system — a separate signaling pathway from the serotonin and norepinephrine routes that traditional antidepressants target. That difference in mechanism is why ketamine can help when those medications haven’t, and why it’s one of the interventional treatments psychiatrists now consider for treatment-resistant depression, PTSD, and chronic pain with a psychological component.
IV ketamine at SMHWI is physician-supervised from start to finish. Every infusion is delivered in a private treatment room with continuous vital-sign monitoring, by staff trained specifically for this treatment, inside an integrated psychiatric practice where your psychiatrist, therapist, and infusion team all talk to each other. If Spravato (esketamine) is a better fit (FDA-approved, insurance-covered, nasal spray), your psychiatrist will say so.
How An IV Ketamine Session Works
What actually happens on infusion day
Every infusion follows the same structure. Here’s what to expect, start to finish.
The IV Ketamine Protocol
What a typical course looks like
The structure of a course of IV ketamine therapy, independent of any individual patient’s outcome. Your psychiatrist individualizes the actual plan.
Who IV Ketamine Is For
Off-label indications and when to consider it
IV ketamine is not a first-line treatment. It’s considered when standard options haven’t worked, and when a comprehensive psychiatric evaluation says you’re a reasonable candidate.
Treatment-Resistant Depression
Adults with major depression that hasn’t responded to adequate trials of at least two antidepressants. The glutamate mechanism is different from standard antidepressants, which is why ketamine can help when they haven’t.
Depression carePTSD
Growing evidence base for ketamine in treatment-resistant post-traumatic stress disorder, particularly when symptoms are severe and standard trauma-focused therapy and medication have not been sufficient on their own.
PTSD careChronic Pain with Psychological Component
Chronic pain conditions with a significant depression or trauma component. Pain management stays with the pain specialist. IV ketamine addresses the psychiatric piece in a coordinated plan.
Request consultationAlternatives worth discussing
IV ketamine isn’t appropriate for uncontrolled blood pressure, certain cardiovascular conditions, pregnancy, active psychosis, or active uncontrolled substance use. Spravato and TMS are alternative interventional options worth discussing.
Compare SpravatoHow IV Ketamine Compares
IV ketamine vs. Spravato
Same molecule family, different treatments. Weigh this with your psychiatrist, not on your own.
Where To Receive IV Ketamine
SMHWI IV ketamine clinics
Pick your closest SMHWI clinic for IV ketamine availability, scheduling, and self-pay pricing.
ScottsdaleArizona
Roland Segal, MDMedical Director, ScottsdaleTempeArizona
Ehab Abdallah, MDMedical Director, TempeGlendaleArizona
Lauren T. Bonner, MDMedical Director, GlendaleRockwallTexas
Ryan H. Hashem, MDMedical Director, RockwallFrequently Asked Questions
IV ketamine therapy, answered
A slow intravenous infusion of racemic ketamine delivered over approximately 40 to 60 minutes under direct physician supervision. Ketamine acts on the brain’s glutamate system, a separate signaling pathway from traditional antidepressants, which is why it can help when other medications haven’t. Used off-label for treatment-resistant depression, PTSD, and chronic pain with a psychological component.
Spravato is esketamine, a single-enantiomer form of ketamine delivered as a nasal spray and FDA-approved for treatment-resistant depression. IV ketamine is racemic ketamine (both enantiomers) delivered as a slow infusion, used off-label, and usually not covered by insurance. Both work on the glutamate system but differ in regulatory status, delivery, cost, and clinical protocol. Your psychiatrist helps decide which is a better fit.
Used off-label for treatment-resistant depression, PTSD, chronic pain with a psychological component, and certain anxiety presentations. Not a first-line treatment. Typically considered when standard medications and therapy haven’t worked.
The infusion itself runs about 40 to 60 minutes. Including check-in, vitals, and recovery, plan on approximately two hours in the clinic. Because of possible sedation and dissociation, you cannot drive yourself home.
IV ketamine is used off-label and is usually not covered by commercial insurance. Each SMHWI location quotes self-pay pricing before you commit. If you have a treatment-resistant depression indication and insurance coverage matters, your psychiatrist may discuss Spravato (esketamine) as a covered alternative.
Most patients describe a sense of dissociation or floating, sometimes drowsiness, sometimes a lift in mood. The experience is handled in a private treatment room with staff monitoring throughout. Dissociative effects typically settle before you leave.
The common initial series is six infusions over 2–3 weeks, followed by individualized maintenance based on response. Your psychiatrist adjusts frequency and dose based on standardized rating scales and your clinical response, not a fixed template.
Medically reviewed
Reviewed by Roland Segal, MD
Double board-certified psychiatrist and member of the Arizona Psychiatric Society. Clinical oversight for SMHWI interventional treatments across Arizona and Texas.
Not sure if IV ketamine is the right fit?
Start with a conversation. A comprehensive psychiatric evaluation is where candidacy, alternatives, and the right next step get worked out, together.
In a crisis
Get help right now
SMHWI is an outpatient practice and cannot respond to emergencies. If you or someone you know is in danger or thinking about suicide, use these free, confidential resources, available 24/7.
- Call 911Life-threatening emergency, or someone at immediate risk of harm.
- Call or text 988Suicide & Crisis Lifeline, 24/7. Chat at 988lifeline.org/chat.
- Dial 988, then press 1Veterans Crisis Line, or text 838255.
- Text HOME to 741741Crisis Text Line, free 24/7 support with a trained counselor.
